REGISTRATION FORM_Public Mental Health

Health and Mental Health Systems

Personal Information

Name(Required)
Gender(Required)
MM slash DD slash YYYY
Address(Required)
Permanent Address (if different)

Educational Background

What is your highest qualification?(Required)
Your photo (optional)
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Certificate, degree, marksheet, transcripts
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Max. file size: 2 GB.
    Certificate, degree, marksheet, transcripts
    Drop files here or
    Max. file size: 2 GB.
      Status of employment

      About You

      The contents of the course may include aspects that are sensitive as we work in the mental health field. If you would like to advise the faculty of anything prior to the course this is the space to do so, so we can adjust material if required. Otherwise once the course starts if you feel like you need to make the faculty aware of anything then their contact details will be made available then.
      (optional)
      Where did you hear about this course?
      Make the payment after registration to the following bank account and please share transaction details below. FEE - INR 5000 Account Name: BALM TRUST KOTAK MAHINDRA BANK A/C NO 8411622477 BRANCH ANNA NAGAR IFSC CODE: KKBK0000469